VALLEY HEALTH PLAN. Covered California Plan & Individual & Family Plan Valley Health Plan

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1 VALLEY HEALTH PLAN Covered California Plan & Individual & Family Plan 2014 Valley Health Plan

2 WELCOME Agenda Goal: To share information about Valley Health Plan (VHP) and establish a relationship with trusted organizations to work together to reach communities in need of health coverage. About Valley Health Plan HMO vs PPO Why Choose Valley Health Plan? Steps to Navigate: VHP Provider Search Steps to Navigate: Covered California Shop and Compare Tool How to Enroll Member Materials 2012 Valley Health Plan 2

3 ABOUT VALLEY HEALTH PLAN For Residents of Santa Clara County As the only locally based health plan in Santa Clara County, we understand the community s health coverage needs. VHP, is a HMO that has been providing health insurance coverage to employer groups since VHP is now publically available, where ANY resident of Santa Clara County can choose quality, affordable health coverage Valley Health Plan 3

4 ABOUT VALLEY HEALTH PLAN Region 7 Service Area County of Santa Clara Northern Area Los Altos Los Altos Hills Mountain View Palo Alto Sunnyvale Central /Eastern Area Milpitas San Jose Santa Clara Western Area Campbell Cupertino Los Gatos Monte Sereno Saratoga Southern Area Gilroy Morgan Hill 2014 Valley Health Plan 4

5 KEY DIFFERENCES BETWEEN HMO VS. PPO Valley Health Plan is an HMO Health Maintenance Organization (HMO) All your health care services go coordinated by a Primary Care Physician Need a referral to see a specialist (except in an emergency) Visits to out-of-network providers are not typically covered Preferred Provider Organization (PPO) No need for a referral to see a specialist Can access care both inside and outside the provider network Typically pay a higher percentage of cost for out-of-network care Choice = Higher Cost Share 2014 Valley Health Plan 5

6 WHY CHOOSE VALLEY HEALTH PLAN? Products Offered Covered California Plan Subsidies may be available based on age, family size and income Proof of legal status, residency, and income required VHP does not offer Small Business Health Options Plan (SHOP) at this time VHP Individual & Family Plan The applicant only needs to sign the application which attests that everything on the application is true Subsidies are not available Mirrored product for rates, copays, provider network, and benefits All plans include Pediatric Dental (Liberty) & Vision (VSP) benefits 2014 Valley Health Plan 6

7 WHY CHOOSE VALLEY HEALTH PLAN? Connecting the coverage you need with the care you deserve Every HMO Qualified Health Plan offers the same essential health benefits and co-pay/coinsurance. Multilingual staff and member materials Lowest HMO prices for the most popular Exchange plans Quality network of primary and specialty care providers Primary Care: Community Clinics, Independent Providers, and Santa Clara Valley Medical Center (SCVMC) Hospitals: Lucile Packard Children s, Saint Louise Regional, SCVMC, and Stanford Safeway and Walgreens pharmacies (Nationwide) Quest Labs (Statewide locations) Free health & wellness services Easy process for non-subsidy eligible applicants to enroll into mirrored VHP Individual & Family Plan 2014 Valley Health Plan 7

8 PROVIDER NETWORK Covered California Plan and VHP Individual & Family Plan 2014 Valley Health Plan 8

9 FREE HEALTH AND WELLNESS SERVICES For All VHP Members Chronic Disease Prevention & Management Classes Diabetes prevention, nutrition, tobacco cessation, Weight Watchers Prenatal Classes Childbirth, Breastfeeding, Labor & Delivery, Infant CPR Fitness Classes Aquatic, Jazzercise, Pilates, Total Body Fitness, Tai Chi, Yoga, Zumba Online Wellness Tools Personal Health Assessment, workshops, recipes, nutrition tracking Care Management Program Disease Management and Complex Case Management 2014 Valley Health Plan 9

10 STEPS TO NAVIGATE: PROVIDER SEARCH Step 1: Visit Valley Health Plan 10

11 STEPS TO NAVIGATE: PROVIDER SEARCH Step 2: Click on Provider Search 2014 Valley Health Plan 11

12 STEPS TO NAVIGATE: PROVIDER SEARCH Step 3: Click Provider 2014 Valley Health Plan 12

13 STEPS TO NAVIGATE: PROVIDER SEARCH Step 4: Filter Results 2014 Valley Health Plan 13

14 STEPS TO NAVIGATE: PROVIDER SEARCH Compare Providers 2014 Valley Health Plan 14

15 STEPS TO NAVIGATE: PROVIDER SEARCH Provider Profile 2014 Valley Health Plan 15

16 STEPS TO NAVIGATE: PROVIDER SEARCH Provider Profile 2014 Valley Health Plan 16

17 STEPS TO NAVIGATE: SHOP AND COMPARE TOOL Step 1: Visit Valley Health Plan 17

18 FIND THE PLAN THAT MEETS YOUR NEEDS Step 2: Input your information 2014 Valley Health Plan 18

19 COVERED CALIFORNIA: VALLEY HEALTH PLAN Step 3: Plan Options (HMO vs. PPO) Highlights You can toggle metal options Tax credits same for all Total monthly premium payments differ by Plan choice 2014 Valley Health Plan 19

20 PLAN PREMIUM COMPARISON Example for a 25 year old 2014 Valley Health Plan 20

21 PLAN PREMIUM COMPARISON Example for a 40 year old 2014 Valley Health Plan 21

22 HOW TO ENROLL Individuals and Families Buying through Covered California Visit coveredca.com Call (toll-free) Buying Directly From VHP Visit valleyhealthplan.org Call (toll-free) 2012 Valley Health Plan 22

23 MEMBER MATERIALS Folder Contents We Speak the Language of Health Covered California Plan (English, Spanish & Vietnamese) Individual & Family Plan (English, Spanish & Vietnamese) Compare and Save Example of premiums for 25-year olds Example of premiums for 40-year olds Summary of Benefits and Coverage (SBC) All Metal Tiers Premium Rates by Age How to Read Your VHP ID Card

24 Thank You!